Uzbekistan’s president Islam Karimov applauds during festivities in Tashkent in March 21 2015. Photograph: Str/AP

The electoral commission reported a whopping 91.08% turnout. To no one’s surprise, the incumbent president won another five-year term, with 90.39% of the vote. Criticism by observers from the Organisation for Security and Cooperation in Europe passed largely unnoticed.

Welcome to Uzbekistan, a country bigger than Germany, with a population of 31 million, where Islam Karimov is now embarking on a fourth term of office, even though the constitution stipulates a two-term maximum for heads of state. Among human rights activists and political dissidents, the gnashing of teeth has already begun.

Steve Swerdlow, a central Asia researcher at Human Rights Watch, said Karimov’s “sham re-election” would condemn Uzbekistan’s citizens to life under virtual totalitarian rule unless the US and European Union began pressuring him to make reforms.

“Torture is systemic in the criminal justice system, millions of Uzbeks are forced to harvest cotton in abysmal conditions each fall and thousands remain imprisoned on politically motivated charges,” he said.

“The fact that Karimov will remain in office for an undetermined period means the loss of even the smallest hopes for changes in the country,” said Umida Niyazova, an Uzbek journalist and activist who emigrated to Berlin in 2009 after being detained for four months on charges of subversion and “religious extremism”. “It means that economic and political stagnation will continue, without any prospect of people’s lives improving.”

Karimov has promised that “there will come a time when our citizens will enjoy complete freedom”, but activists expect that his fourth term will bring more of the same repressive governance. Political competition is nonexistent, much of the opposition has been driven abroad or imprisoned, the internet and media are heavily censored and reports of arbitrary imprisonment and torture are frequent.

A Human Rights Watch report published last September highlighted the extent of the regime’s crackdowns on the political opposition, Muslims and street protesters. According to the report, an estimated 10,000 to 12,000 political opponents have been imprisoned. Of 34 prisoners profiled in detail by Human Rights Watch, 29 have made credible allegations of torture or ill-treatment, including beatings, electric shocks, hangings from wrists and ankles and meagre allowances of food and water. In the past, some prisoners have even reportedly been boiled alive.

Meanwhile, the country’s large cotton industry, notorious for pressing even small children into jobs, has been highlighted again after National University of Uzbekistan students wrote an open letter in November complaining of being forced to pick cotton without pay.

Despite the attacks, Karimov has become ever more autocratic. Explaining his decision to seek a fourth term, he said last year: “They criticise me, but I want to keep working. What’s wrong with that?”

The regime has been paying even less attention to keeping up the facade of a democratic process, according to Daniil Kislov, editor of the central Asian news portal Fergana.ru, which has been banned in Uzbekistan. “In previous elections, police went house to house and invited people to go to vote, but for the recent presidential and parliamentary elections the authorities didn’t even care to create the illusion of activity,” he said.

“Political repressions and restrictions on human rights and freedoms will increase,” predicted Nadejda Atayeva, an Uzbek human rights activist who fled to France in 2000. “It’s not only critics of the regime and representatives of religious organisations and communities who are under threat; the authorities have targeted those who have lived abroad for more than three months.”

Meanwhile the west has continued to supply Uzbekistan with weaponry. In 2003, Tony Blair’s government granted Uzbekistan a licence to import British arms. This year it was revealed that the United States plans to give Tashkent 328 military vehicles worth nearly $350m, a move clearly intended to buy goodwill in a country strategically placed next to Afghanistan and in Russia’s and China’s backyards.

Despite the lack of international pressure, changes could be looming just over the horizon for Uzbekistan. Karimov is 77, and his disappearance from public view for three weeks in February sparked rumours that his health was flagging.

The president’s daughter, Gulnara Karimova, is apparently under house arrest having ‘fallen from grace’. Photograph: Pascal Le Segretain/Getty

No clear successor has emerged: the leader’s favourite daughter and heir apparent, Gulnara, a would-be pop star, named the “most-hated person” in the country in a leaked diplomatic cable, fell from grace last year amid mounting corruption accusations involving the Swedish telecoms company TeliaSonera and others.

Although the state of the economy remains difficult to ascertain beyond dubious official figures, huge sums are lost to corruption. Transparency International has called Uzbekistan one of the world’s 10 most corrupt countries.

Despite reports of an 8% increase in GDP last year, living standards and employment do not appear to be rising, with an estimated 5-6 million Uzbeks going abroad to find work each year. According to Atayeva, the black market dollar exchange rate has been shooting up, indicating that there are growing economic worries among the cash-strapped population.

After the rouble lost half its value in 2014, many of those working abroad in Russia were starting to come back home – where they were less likely to find work and could make an ideal recruiting ground for Islamic extremism, Kislov said.

The Islamic Movement of Uzbekistan has been operating over the border in Afghanistan for more than two decades, while an estimated 2,000 to 4,000 central Asians are fighting with Islamic State (Isis), most of them thought to be Uzbeks.

Uzbekistan’s intelligence agency said last month that it had intercepted communications indicating that Isis would attempt to carry out attacks in the country this spring. If Karimov’s fourth term is spent battling an Islamist threat, Uzbeks will be waiting a long time for the promised era of “complete freedom” to begin.